Approved form 2001-16

made under the
Drugs of Dependence Act 1989

Drugs of Dependence Act 1989—Form 3
(see s 103)

First-aid register
Institution and location	
Drug1.................................Strength1........................Form1..............................

Date2	Name and Address3	Dealing4	In5	Out5	Balance6	Remarks	Counter
signature7	Signature8	
									
1	One drug, 1 strength, 1 form only per page of register.
2	Date of dealing.
3	Name and address of supplier, or person to whom the drug is administered (if the latter is ascertainable).
4	Nature of dealing—whether receipt, administration, surrender, loss or theft.
5	Quantity of the drug coming in or going out.
6	Quantity of the drug still held.
7	If the drug is disposed of—countersignature of the drug inspector who authorised the disposal.
8	Signature of the person making the entry in the register.

Endnote
This form was originally in the Drugs of Dependence Act 1989, schedule 4.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from that schedule and became a form approved under the Drugs of Dependence Act 1989, section 205 (see amdts 1.1222 and 1.2223).

©  Australian Capital Territory 2001